CAJ | 학술논문

目的总结中国Ⅲ类和Ⅰ类心脏死亡供体在肝移植应用中的近期效果.方法回顾性分析2011年9月-2014年6月在广东佛山市第一人民医院完成的中国Ⅰ类心脏死亡捐献供体(DBD组)和Ⅲ类心脏死亡捐献供体(DBCD组)肝移植的临床资料.结果 DBD组和DBCD组分别有12例和21例受体,两组术前供、受体年龄、原发病、肝功能指标ALT、TBIL、ALB、供肝冷缺血时间、受体MELD评分无明显差异,两组术中出血量、输血量、手术时间、无肝期差异无统计学意义,P＞0.05;DBD组和DBCD组术后中位随访时间分别为8.8个月和20个月,两组肝移植受体和移植物累积生存率均为100％,术后ICU住院时间、术后肝功能恢复时间、术后住院时间、早期并发症、急性排斥反应发病率差异均无统计学意义,P＞0.05.结论中国Ⅲ类心脏死亡供体(DBCD)肝移植能取得与中国Ⅰ类心脏死亡供体(DBD)肝移植一样的近期效果,详细的供体评估、规范的供体器官获取流程、缩短冷供肝缺血时间、保护供肝胆管周围微血管网、加强围手术期的管理和长期随访是提高中国Ⅲ类心脏死亡供体肝移植受体生存率的关键.
목적 총결중국Ⅲ류화Ⅰ류심장사망공체재간이식응용중적근기효과.방법 회고성분석2011년9월-2014년6월재엄동불산시제일인민의원완성적중국Ⅰ류심장사망연헌공체(DBD조)화Ⅲ류심장사망연헌공체(DBCD조)간이식적림상자료.결과 DBD조화DBCD조분별유12례화21례수체,량조술전공、수체년령、원발병、간공능지표ALT、TBIL、ALB、공간랭결혈시간、수체MELD평분무명현차이,량조술중출혈량、수혈량、수술시간、무간기차이무통계학의의,P＞0.05;DBD조화DBCD조술후중위수방시간분별위8.8개월화20개월,량조간이식수체화이식물루적생존솔균위100％,술후ICU주원시간、술후간공능회복시간、술후주원시간、조기병발증、급성배척반응발병솔차이균무통계학의의,P＞0.05.결론 중국Ⅲ류심장사망공체(DBCD)간이식능취득여중국Ⅰ류심장사망공체(DBD)간이식일양적근기효과,상세적공체평고、규범적공체기관획취류정、축단랭공간결혈시간、보호공간담관주위미혈관망、가강위수술기적관리화장기수방시제고중국Ⅲ류심장사망공체간이식수체생존솔적관건.
Objective To compare the short term outcome after liver transplantation with donor aftercardiac death of China category Ⅲ and China category Ⅰ.Methods The clinical data of the liver transplantation with donor after cardiac death of China category Ⅲ(DBCD group) and China category Ⅰ (DBD group) performed at The First People's Hospital of Foshan from November 2011 to June 2014 were retrospectively analyzed.Results There were 12 recipients and 21 recipients in the DBD and DBCD group respectively.The difference of age,primary disease,serum alanine aminotransferase (ALT),total bilirubin (TBIL),albumin(ALB) levels of the liver donors and recipients,cold ischemia time of the donor and model for end liver disease(MELD) score of the recipients before surgery between the two groups was not significant,P ＞ 0.05;There no significant difference of operation time,anhepatic time,estimate blood loss and required blood transfusion through operation between the two groups,P ＞ 0.05;At the median follow up of 8.8 months in the DBD and 20 months in the DBCD group respectively,no significant difference of grafts and recipients survival,intensive care unit(ICU) stay,hospitalization after operation,liver allograft function recovery,early complication incidence,acute rejection incidence between the two groups was found,P ＞ 0.05.Conclusions The short term outcome after liver transplantation with donor after cardiac death of China category Ⅲ was similar to that with donor after cardiac death of China category Ⅰ.The good evaluation of the donor,standard organ procurement protocol,reducing cold ischemia time,maintaining the capillary network around the bile duct,enhancing the perioperative management and follow up were the key important elements for the improvement outcome after liver transplantation with donor after cardiac death of China catego